Providing responsible medical translations at every step of the way during the healthcare journey is a major challenge for a health organization. In the Healthcare industry, many foreign language speaking patients go through a fragmented system of healthcare translation services as means to understand their care. While there are language access requirements for medical care, providers are not necessarily required to demonstrate that they provide qualified translations. In addition to our regular translation of healthcare communications that we do for our clients, we have received many requests by Medical Centers to keep our phone interpreting services at hand for any immediate language interpretation needs. But patients go through many more phases in their care. They talk with doctors, sign forms, read information online or in books, and receive a lot of plan information and disease management information from their providers.
Professional and Certified Medical interpreting provides patients with responsible in-person translation services while they are at the doctor’s office or hospital. Many patients still rely on “filtered” information through their families or friends, causing gaps to exist between the understanding of the patient and the healthcare provider. Medical interpretation is a highly responsible job as it often includes decision making and binding forms and contracts that ultimately affect a patient’s outcome. Medical interpreting also deals with empathy for the patient. While physicians are learning to become more culturally competent, a medical interpreter may recognize cultural barriers that make it harder to get to the information needed to diagnose a patient. Medical interpreting standards are governed by the National Standards of Practice of the National Council on Interpreting in Health Care (NCIHC).
When written translations are instructional or informational, it is important that the content is written clearly to affect behavior. Keep in mind that foreign language speaking patients experience a healthcare system that’s dominated by confusing concepts and sometimes inconsistent terminology. Oftentimes, the English could use a bit of help by writing materials in Plain Language or using Health Literacy concepts to increase understanding and impact positive behavior changes.
Patients deal with information that is not only foreign in language, but also often foreign in concept. It’s a challenge to bring together the health experience at home with the health experience in the United States using content that is typically written for the English speaking audience. Challenges are consistency in terminology, concepts that need to be understood as experienced in the US healthcare system, and cultural concepts that may inhibit patients to either understand or follow directions that do not make sense.
Confusing Healthcare Concepts
We’ve written about cultural concepts before in an example with the Meal Plate. However, there are also certain expectations that need to be considered in the language. Ambiguous language such as the word “physician” does not always translate and require more specific terminology. It’s important to know what kind of physician is being referenced (is it a prescribing physician like a doctor, or can it include nurses?). Symptoms like wheezing are linguistically a very challenging concept in Spanish because there are many more descriptions available that may or may not be relevant. Therefore, it’s important not to just translate with a dictionary and translation resources, but to work with a team that understands how to communicate to patients and effectively lead them to make the decisions that are intended and relevant to their health situations for responsible Medical Translations.
Written translations can also be legally binding, such as privacy practices, consent forms, explanation of benefits, etc. If the translation leads to misunderstandings due to mistranslations, this could have legal consequences. The challenge here often is that considerable investment has to be made for professional translation of long legal documents. It’s often much more cost efficient to have documents read to them in their language through an interpreter or a relative. Even if the person needing help in a foreign language gets legal counsel, there is a difference between interpreting legal advice through an attorney and having that relayed by an interpreter versus having a person sign documents that is interpreted to them on the spot. It’s not a practice that is recommended and can lead to people having to make decisions without having all the correct information. The American Bar Association sets standards on translation and interpretation.
There are also financial consequences when families make decisions about their care and health insurance needs. The terminology around financial concepts in healthcare are already confusing to most Americans. Without clear guidance on what the patient’s rights and responsibilities are (as typically explained in the Explanation of Benefits), there is a good chance that families are not making the right decisions to choose the right plan for their situation, make the appropriate decisions on how to submit claims and also risk losing out on benefits they are entitled to. It’s also important to be consistent and clear in terminology as many families go through brokers and seek out personal help through local organizations who can help them in their language. It’s especially important in written communications to continue to explain concepts by using consistent terminology, but also to use examples and definitions to help the reader get familiar with the most important financial concepts, such as deductibles, out-of-pocket costs, copay, coinsurance, limits, in-network, out-of-network and premiums. All these concepts can be intimidating and confusing, but they all make part of the important decision to choose a health plan and responsible decision making.
How and When to Provide Responsible Medical Translations
Every organization tasked with providing health information to members or patients with Limited English Proficiency (LEP) should know that they not only are legally responsible to provide language assistance in certain cases, but it is also in their best interest to make sure that this is done in a responsible and accurate manner. Every organization should find out how to assess Language Assistant needs for their patients or members on their own. Sometimes there are legal consequences involved such as the Section 1557 directive that’s affected most medical centers who receive HHS reimbursements or cover Health Insurance Marketplace plans.
Many organizations already track patient outcomes and understand the costs of patient behavior that’s not managed well. Use that data to see if there are any discrepancies with certain patient populations and whether there are any language deficiencies that need to be addressed. Make an inventory of your patient interactions and how you would handle Language Assistance and whether that approach is helping or hurting the patient in their understanding (it could be something simple as tracking patient no-shows, patient call-ins, patient readmissions).
Also look at suitability of the services. Medical interpretation can be crucial in emergency situations and is definitely helpful in creating empathy and building relationships with doctors and other physicians and to receive adequate care, but it might not be the best option to help them fill out forms or retain information to bring back to their family in the decision making process. As many organizations are moving to more risk based assessment thinking in their quality management, consider adding your Limited English Proficient patient population in that assessment.
And as always, if you need any help, please contact Language Solutions for Healthcare Translation needs.